The OOPS procedure (Operation on Placental Support): In utero airway management of the fetus with prenatally diagnosed tracheal obstruction

Skarsgard, Erik D.; Chitkara, Usha; Krane, Elliot J.; Riley, Edward T.; Halamek, Louis P.; Dedo, Herbert H.

doi:10.1016/s0022-3468(96)90144-x

Cited by 110 publications

(77 citation statements)

References 9 publications

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“…This method may ensure uninterrupted oxygenation of the fetus until the preparation for resection of the epignathus can be performed [16] . However, in spite of the improved possibilities of treatment, intubation and oxygenation of the newborn might be difficult and can fail due to the enormous size of the tumor making an OOPS not always feasible.…”

Section: Discussionmentioning

confidence: 99%

Prenatal Diagnosis of an Epignathus Associated with a 49,XXXXY Karyotype – A Case Report

Staboulidou¹,

Miller²,

Göhring³

et al. 2008

Fetal Diagn Ther

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Background: Epignathus is a rare form of congenital teratoma, originating from the base of the skull, most commonly the hard palate, or mandible. It has been associated with a poor prognosis due to complications including polyhydramnios and respiratory compromise at birth as a consequence of upper airway obstructions. It is usually not associated with chromosomal aberrations. We present a case of prenatally diagnosed epignathus associated with a gonosomal pentasomy 49,XXXXY. Case: A 34-year-old gravida 1, para 0 was referred to our unit with a sonographically suspected gastroschisis at 26+6 weeks’ gestation. A detailed ultrasound scan revealed a large mixed echogenic mass seen in continuation with the mouth in the midline. Based on the appearance, an epignathus was suspected. No other fetal anomalies were detected. Karyotyping showed a 49,XXXXY karyotype of the fetus. The couple decided to continue the pregnancy after detailed counseling about results and prognosis. A cesarean section was necessary and performed at 29+0 weeks’ gestation due to a pathological Doppler and cardiotocogram. Because of the enormous epignathus intubation of the newborn was not possible. A tracheostomy was performed for ventilation and oxygenation, which failed and the newborn died 30 min after birth. Conclusion: Prenatal diagnosis by ultrasound has improved perinatal management. This should include assessment of the tumor size and spread in order to establish an accurate prognosis and to anticipate likely problems which are to be encountered during pregnancy or at the time of delivery. To our knowledge, this is the first reported case of a prenatally diagnosed epignathus with a gonosomal pentasomy 49,XXXXY.

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Section: Discussionmentioning

confidence: 99%

Prenatal Diagnosis of an Epignathus Associated with a 49,XXXXY Karyotype – A Case Report

Staboulidou¹,

Miller²,

Göhring³

et al. 2008

Fetal Diagn Ther

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“…10 The use of extracorporeal membrane oxygenation to support the neonate in the case of an airway obstruction has been described previously. Recently, the OOPS (Operation On Placental Support) method 19 has been reported to provide oxygen to the infant through the placenta on cesarean section so that evaluation of the airway and endotracheal intubation or tracheotomy can be safely performed. 19 The prognosis of pharyngeal teratoma is poor.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, the OOPS (Operation On Placental Support) method 19 has been reported to provide oxygen to the infant through the placenta on cesarean section so that evaluation of the airway and endotracheal intubation or tracheotomy can be safely performed. 19 The prognosis of pharyngeal teratoma is poor. 1,12 It depends mainly on the size of the lesion and the involvement of vital structures.…”

Section: Discussionmentioning

confidence: 99%

Prenatal diagnosis and management of fetal pharyngeal teratoma: A case report and review of the literature

Efthimiou

Pilalis

Papadopoulos

et al. 2007

J of Clinical Ultrasound

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We present a case of a fetal pharyngeal teratoma, which was diagnosed at 21 weeks' gestation. At the time of examination, a mass of mixed echogenicity was detected that protruded through the mouth. During a second examination 3 weeks later, the tumor had increased in size, and a severe polyhydramnios had developed. Intrauterine death of the fetus was detected at 27 weeks' gestation. Labor was induced with misoprostol, and a 1,015-g stillborn female neonate was delivered. Postmortem examination confirmed the diagnosis of a pharyngeal teratoma.

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“…En 1992 se describe el primer caso exitoso de esta técnica, que posteriormente se estandariza en 1997 para el manejo de las hernias diafragmáticas con el objetivo de solucionar la obstrucción endoluminal traqueal creada prenatalmente con el objetivo de favorecer el desarrollo y crecimiento pulmonar al impedir la salida del líquido generado por los pulmones hacia la cavidad amniótica y así mejorar el pronóstico de estos niños. En este período inicial hubo grupos que usaron otras denominaciones para el procedimiento, como OOPS (operation on placenta support) 6,7 y AMPS (air way management on placental support), pero actualmente se engloban en el término EXIT.…”

Section: Exit (Extrauterine Intrapartum Treatment) Primer Caso En Hounclassified

EXIT (Extrauterine Intrapartum Treatment), primer caso en hospital público chileno

G¹,

E²,

S³

2009

Rev. Otorrinolaringol. Cir. Cabeza Cuello

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El procedimiento EXIT se basa en la mantención de la circulación maternofetal mientras se realizan procedimientos para establecer una vía aérea segura en el feto con alto riesgo de presentar una vía aérea no permeable o no segura al nacer. Presentamos el primer caso en que se realiza este procedimiento en un hospital del sistema público de salud chileno (Complejo Asistencial Dr. Sótero del Río), para luego señalar las principales bases teóricas e historia del desarrollo de este procedimiento.Palabras clave: EXIT, cirugía intraparto extrauterina. ABSTRACTThe EXIT procedure is based on developing the necessary procedures to establish a secure airway while maintaining fetomaternal circulation in fetuses with high risk of presenting a compromised airway. We present the first case in which an EXIT procedure was developed in a hospital of the Chilean public health system (Complejo Asistencial Dr. Sótero del Río), and discuss the main theoretic bases and history of the development of this procedure.Key words: EXIT, extrauterine intrapartum treatment. INTRODUCCIÓNCon el desarrollo de la ecografía obstétrica en los últimos tiempos, y el más reciente desarrollo de la resonancia nuclear obstétrica, ha sido posible el diagnóstico prenatal y detallada caracterización de gran cantidad de malformaciones congénitas en los fetos. Entre estas malformaciones se encuentran las de cabeza y cuello que pueden potencialmente llevar a obstrucción de la vía aérea, comprometiendo la sobrevida del feto al nacer debido a la finalización de la circulación e intercambio gaseoso útero-placentario que ocurre en dicho momento. El procedimiento EXIT consiste en mantener la circulación materno-fetal hasta lograr asegurar la vía aérea del recién nacido. Está indicado en casos en que el riesgo de obstrucción de la vía aérea al nacer sea muy alto, ya sea por tumores que

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The OOPS procedure (Operation on Placental Support): In utero airway management of the fetus with prenatally diagnosed tracheal obstruction

Cited by 110 publications

References 9 publications

Prenatal Diagnosis of an Epignathus Associated with a 49,XXXXY Karyotype – A Case Report

Prenatal Diagnosis of an Epignathus Associated with a 49,XXXXY Karyotype – A Case Report

Prenatal diagnosis and management of fetal pharyngeal teratoma: A case report and review of the literature

EXIT (Extrauterine Intrapartum Treatment), primer caso en hospital público chileno

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